CPP / Vasopressors / Cardiac Output

Alex Rosenberg

Disclosures

• I am not a neuro-intensivist!

• I am interested in haemodynamic monitoring and critical care ultrasound.

CPP

• Systemic Hypotension increases morbidity and mortality from TBI.

• Intracranial hypertension increases morbidity and mortality from TBI.

• CPP = MAP – ICP

Brain Trauma Foundation

• 1995

• CPP>70

Is Low CPP Harmful?

Clinical Data

Brain Trauma Foundation Guidelines 2007

• CPP is a valuable monitoring parameter.

• Critical threshold is between 50 and 60mmHg

• Do not substitute CPP for monitoring and management of either of its constituent parameters.

Is high CPP beneficial?

Good Protoplasm?

79 Year Old Lady with SAH. 59mls/Hr Noradrenaline. Map 62

63 year old SAH MAP 70 Norad @ 23mls/hr

38 year old ICH

46 year old SAH

24Year old TBI

How to monitor?

Take Home Messages

• CPP should be kept 50 – 60.

• Neurosurgical patients have abnormal hearts.

• Cardiac Output is beneficial.

• Non invasive monitoring is possible.

Thank you.